A New Approach to the Treatment of Neurological Pathologies Fred Kahn, MD, FRCS(C) September 30, 2015 Montreal, Canada
The Brain “ The Mirror of the Soul” www.drjennybrockis.com/dr-jenny-brockis/2014/10/12/for-greater-mental-performance-start- http://www.nildcanada.org/wp-content/uploads/iStock_000013247635XSmall.jpg with-a-high-performance-brain 2
The Brain 3
Mechanism of Injury http://www.braininjury.com/injured.shtml 4
Symptoms 5
Dr. Norman Doidge Psychiatrist, psychoanalyst, researcher, and author. He is on faculty at the University of Toronto’s Department of Psychiatry, and Research Faculty at Columbia University’s Center for Psychoanalytic Training and Research, in New York. 6
The Center for Disease Control and Prevention defines Concussion as: A concussion is a type of traumatic brain injury — or TBI — caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, stretching and damaging the brain cells and creating chemical changes in the brain. http://www.cdc.gov/traumaticbraininjury/get_the_facts.html 7
Pathophysiology of Concussion Figure 2. Following TBI there is a neuroinflammation with down-regulation of astroglial Figure 1. Schematic drawing of a synapse with glutamate is being glutamate transport systems. If this state is not restored completely, there will be an converted to glutamine in the astrocyte and transported back to the impaired extracellular glutamate clearing with slightly increased extracellular presynaptic terminal where glutamine is converted back to glutamate. glutamate levels, slight astrocyte swelling and impaired glucose uptake. Neuronal During this process, and with decreasing ATP levels as the signal, glucose activity, if long-lasting, may result in energy crisis. is taken up from the blood to supply neurons and astrocytes with energy. Johansson, Birgitta and Rönnbäck, Lars. Neuroscience: Traumatic Brain Injury (2014). InTech. 8
Incidence • TBI is a contributing factor to a third (30%) of all injury-related deaths in the United States. • Approximately 25% of soldiers returning from war-zones in Iraq, Afghanistan, etc. are affected by variations of this type of trauma. • Within the past 10 years, the diagnosis for concussion in high school sports participants has increased annually by 16.5%. • In 2009-2010, over 14,000 concussion related injuries were reported to the National Ambulatory Care Reporting System reflecting visits to an Ontario Hospital ER. • Direct medical costs and indirect costs such as lost productivity totalled $60 billion in the US in the year 2000. 9
Possible Therapies Reassurance, Discussion, Compensatory Strategy Neurocognitive Rehabilitation Cognitive rest Medications Chiropractic Therapy Craniosacral Therapy Vestibular Rehabilitation Therapy Low Levels Laser Therapy (LLLT) 10
LLLT Physiological Effects Ying-Ying Huang, Asheesh Gupta1, Daniela Vecchio1, Vida J. Bil de Arce1, Shih-Fong Huang1, Weijun Xuan1, and Michael R. Hamblin. Transcranial low level laser (light) therapy for traumatic brain injury. J. Biophotonics 5, No. 11 – 12, 827 – 837 (2012) 11
Neuromodulatory Effects of Laser Therapy 3 Phases: 1. Direct Effect Photon Particle directly interacting with surrounding neurological, connective and skeletal tissues 2. Indirect Effect Circulating photons are absorbed by CSF and scattered to CNS via ventricles 3. Humoral Effect Distribution of photon particles to all tissues in the body 12
Meditech Clinic in Toronto 13
Case Study 1 66 year old man Patient visiting Toronto clinic for 1 week from another country CC: Chronic Depression HPI: ⁻ Sustained severe concussions at age 18 and 22 ⁻ Cognitive impairment The Diagnosis formulated was: 1. Cerebral Concussion Tx: Daily Laser Therapy for one week at clinic in Toronto ⁻ Improvement in depressive mood, “Brain Fog” , short term memory ⁻ In order to sustain this patient’s improved status, he was instructed to carry on with periodic therapy utilizing a Home Therapy System. Patient Goal : Return to work full-time in 6 weeks 14
Case Study 2 15 year old male student Sustained concussion in a wresting competition CC: ⁻ Severe headaches (24/7), tinnitus, noise and light sensitivity, sleep difficulties, and sever stutter ⁻ High doses of Aspirin and Tylenol with little improvement ⁻ Was unable to attend school ⁻ Severe depression PE: ⁻ ROM of Cervical Spinal 20% of Normal ⁻ Tenderness on palpation, extending form occiput to T2 level The Diagnosis formulated was: 1. Cerebral Concussion 2. Myofascitis – Cervical Spine Tx: ⁻ Laser Therapy was instituted in late February and extended to March 18, 2015 ⁻ First 5 treatments, symptoms had subsided in excess of 60% ⁻ Returned to school full-time 4 weeks post-initiation of Laser Therapy 15
Case Study 2 15 year old male student Sustained concussion in a wresting competition CC: ⁻ Severe headaches (24/7), tinnitus, noise and light sensitivity, sleep difficulties, and sever stutter ⁻ High doses of Aspirin and Tylenol with little improvement ⁻ Was unable to attend school ⁻ Severe depression PE: ⁻ ROM of Cervical Spinal 20% of Normal ⁻ Tenderness on palpation, extending form occiput to T2 level The Diagnosis formulated was: 1. Cerebral Concussion 2. Myofascitis – Cervical Spine Tx: ⁻ Laser Therapy was instituted in late February and extended to March 18, 2015 ⁻ First 5 treatments, symptoms had subsided in excess of 60% ⁻ Returned to school full-time 4 weeks post-initiation of Laser Therapy 16
Case Study 3 10 year old female student 1 st Concussion - 8 months 2 nd Concussion - March 2014 while skiing 3 rd Concussion – January 2015 competing as a gymnast in trampoline competition CC: ⁻ Cognitive impairment, headaches, blurred vision, hypersensitivity to external stimuli, dizziness, irritability and highly labile mood swings HPI: ⁻ Sustained extensive laceration over the occiput w/ LOC PE: ⁻ ROM of the Cervical Spine was 80% of normal ⁻ Edema and tenderness over the occipital area ⁻ Laceration healing satisfactorily The Diagnosis formulated was: 1. Cerebral Concussion (x3) 2. Myofascitis – Cervical Spine 3. Occipital Soft Tissue Injuries/Laceration Tx: Total of 15 treatments were applied with overall improvement 17
Case Study 4 40- year- old secretary feel down 13 stairs Sustained Basal Skull Fracture LOC indeterminate period of time CC: ⁻ Constant headaches most sever in the occipital lobe , dizziness, lack of energy, depression and difficulty sleeping. PE: ⁻ ROM of the Cervical Spine was 70% of normal ⁻ Edema and tenderness over the occipital area to T2, posterior aspect of the cranium external to the cerebellum and the posterior hemispheres The Diagnosis formulated was: 1. Cerebral Concussion (x3) 2. Myofascitis – Cervical Spine 3. Basal Skull Fracture Tx: From a global perspective an 80% improvement level was noted over the course of 10 Laser Therapy sessions. 18
Conclusion Bioflex Laser Technology is presently treating 10-15 cases/wk At Meditech Clinic, we have learned to better understand the mechanisms of action instrumental in the induction of traumatic brain injuries As our experience in treating this growing body of patients increases, we are confident in our ability to offer definitive solutions in the treatment of these conditions. 19
Thank You! 20
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